Patients With HIV, Undergoing Cardiac Surgery Have Increased Risk of Pneumonia

Individuals who are HIV-positive and are undergoing cardiac surgery have higher rates of pneumonia and hospital readmission, according to results of a study published in JTCVS Open. In the study, investigators aimed to determine the effects of cardiac surgery on those with HIV.¹

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In a study published in Frontiers in Public Health, the study authors established that post-operative pneumonia can be associated with severe clinical outcomes, including longer hospital stay, higher intensive care unit occupancy, higher unplanned re-operations, and higher in-hospital mortality. The results also showed that significant risk factors include increased age, emergency surgery, chronic obstructive pulmonary disease (COPD), and prolonged ventilation. For those in the study, cardiac and vascular operations were associated with a 2.29% rate of post-operative pneumonia.²

In the current study, investigators used the Pearl Diver Database to find hospital admissions from 2010 to 2020, according to the study.¹ This included 14,714,743 patients, with 59,695 in the HIV-positive cohort. The study authors noted that those with HIV were younger, more often male, more frequently smokers, polysubstance users, obese, and had higher rates of hypertension. However, there were no differences regarding heart failure and patients with HIV had lower rates of baseline coronary artery disease (CAD), according to the results. Patients with HIV who were undergoing surgery had higher rates of hypertension, COPD, and chronic liver, lung, and kidney diseases, compared to those who were not undergoing cardiac surgery. Furthermore, those with HIV who underwent surgery were more likely to undergo mitral valve repair/replacement and were less likely to undergo aortic valve replacement (AVR).¹

The study investigators reported that a higher rate of pneumonia was found for those with HIV compared to those without HIV, at 2.67% and 1.54%, respectively. Similarly, those with HIV were more likely to be readmitted to the hospital within 30 days, at 15.96% and 12.05%, respectively. There were no observed differences for average length of hospital stay, rates of stroke, post-operative heart failure, myocardial infarction, or renal injury, according to the study authors.¹

Following a coronary artery bypass graft, those with HIV experienced only higher rates of pneumonia, while those undergoing AVR had higher rates of pneumonia, readmission, and longer than average hospital stays, according to the results. Additionally, those who underwent mitral valve repair/replacement had an increased risk of pneumonia and 30-day readmission, the investigators said. There were no outcomes associated with aortic surgery.¹

Investigators concluded that the majority of those who experienced higher rates of poor outcomes were younger and had comorbid conditions. They said that among patients living with HIV, HIV-related and bacterial infections are leading causes of hospital admission. This calls for extra consideration for patients with HIV due to pneumonia being a bacterial infection, which investigators cited as one of the leading cause of hospitalization for patients with HIV.¹

One limitation of the study was the lack of granular information on clinical HIV variables, including information on antiretroviral treatment. The authors said that there might be more to learn about this patient population when this data was collected.¹

References

1. Zafeh AV, Justicz A, Plate J, Cortelli M, Wang I, Melvan JN. Human Immunodeficiency Virus Infection Is Associated with Greater Risk of Pneumonia and Readmission after Cardiac Surgery. JTCVS Open. 2024. doi: https://doi.org/10.1016/j.xjon.2024.01.002
2. Xiang B, Jiao S, Si Y, Yao Y, Yuan F, Chen R. Risk Factors for Postoperative Pneumonia: A Case-Control Study. Front Public Health. 2022;10:913897. doi:10.3389/fpubh.2022.913897